Organization
GUAYNABO HEALTH PROVIDERS, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILIANA MEDINA OTERO (PRESIDENT)
(787) 720-5050
Entity
Organization
Contact information
Practice address
140 AVE LAS CUMBRES, GUAYNABO MEDICAL MALL, GUAYNABO, PR 00969-5523
(787) 720-5050
(787) 720-4949
Mailing address
140 AVE LAS CUMBRES, SUITE 210, GUAYNABO, PR 00969-5523
(787) 720-5050
(787) 720-4949
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
261QE0002X
Emergency Care Clinic/Center
12-095
PR
261QE0002X
Emergency Care Clinic/Center
Primary
3
PR
261QE0002X
Emergency Care Clinic/Center
57
PR
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0206X
Mammography Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
PR
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HB327A
MEDICARE PTAN
—
Enumeration date
12/12/2011
Last updated
02/11/2014
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